Erectile Dysfunction
Trouble getting or keeping an erection. Very common, very treatable, and sometimes an early warning from your blood vessels. Worth a proper check-up, not just a script.
How common: more than 1 in 10 men, and more with age. Occasional problems are normal and usually down to stress, tiredness or alcohol.
Why it happens: blood vessels (high blood pressure, cholesterol, diabetes, smoking), nerves, hormones (low testosterone, thyroid), some medicines (for blood pressure, depression or prostate cancer) and the mind (performance anxiety, stress, depression, relationship strain). Often a mix.
The heart link: erection problems can be the first sign of heart disease, diabetes, high blood pressure or high cholesterol. Expect your GP to check blood pressure, blood sugar and cholesterol, and testosterone (on a morning sample) if needed.
The erection ladder
Check the heart and the blood sugar, fix what’s fixable, then use tablets properly before deciding they don’t work.
- Step 1 · Self-careHeart-healthy habitsStop smoking, move daily, lose weight if needed, keep alcohol low and manage stress. Heavy cyclists (3+ hours a week) may benefit from a break.
- Works
- The recommended first step; benefits weren’t measured precisely in trials
- Cost
- Free
- How long
- Months
- Watch for
- Stopping smoking is the biggest single win for blood vessels.
What’s good for your arteries is good for all your arteries.
- Step 2 · PrescriptionErection tablets (sildenafil, tadalafil and others)Taken 1–2 hours before sex; tadalafil can also be taken as a low daily dose. They need sexual arousal to work.
- Works
- Work for many men, though not all; the different tablets work about equally well
- Cost
- Not PBS-subsidised for most people; generic private scripts are fairly cheap
- How long
- Judge over 5–6 attempts
- Watch for
- Never with nitrate heart medicines or amyl nitrite (“poppers”): risk of a dangerous blood pressure drop. Headache, flushing, blocked nose, reflux.
One nervous night is not a fair trial.
- Step 3 · Allied healthCounselling or sex therapyFor anxiety, relationship issues or when tablets alone don’t help. Partners are welcome.
- Works
- Recommended when psychological factors play a big part, often alongside medicine
- Cost
- About $150–250 a session; Medicare rebates with a GP mental health treatment plan
- How long
- Several sessions
- Watch for
- Look for a therapist trained in sexual health.
The brain is the most important sex organ. It also overthinks.
- Step 4 · PrescriptionPenile injectionsA medicine injected into the side of the penis, taught by a clinician. Erections start within 10–15 minutes.
- Works
- An option when tablets don’t work or aren’t suitable
- Cost
- Private script; cost varies
- How long
- Used as needed
- Watch for
- An erection lasting more than 4 hours is an emergency.
Sounds dreadful, but the needle is tiny.
- Step 5 · Self-careVacuum pump and ringA tube draws blood into the penis and a ring holds it there.
- Works
- High satisfaction reported; drug-free, and useful after prostate surgery or with diabetes
- Cost
- One-off cost, often a few hundred dollars
- How long
- Reusable
- Watch for
- Fiddly at first; bruising.
Low-tech, no side effects, surprisingly popular.
- Step 6 · SpecialistUrologist: implantsA surgically placed implant for when other treatments fail.
- Works
- Highly effective whatever the cause, but irreversible
- Cost
- Specialist fees vary; Medicare rebates with a GP referral
- How long
- Permanent
- Watch for
- Surgical risks such as infection.
The last resort that actually works.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Erection pills bought online without a prescriptionThey may be fake, the wrong dose or contaminated. Suspected counterfeits can be reported to the TGA in Australia.
- “Herbal” erection boostersUnregulated and untested. If one works, ask what’s really in it.
- Low-intensity shockwave therapyEvidence that it works isn’t robust yet, and courses are expensive.
- Testosterone with normal levelsOnly helps when a properly timed morning test shows low testosterone.
What you can do
- See your GP for a heart and sugar check, not just a script.
- Take tablets 1–2 hours before, avoid a big meal or alcohol beforehand, and give them 5–6 tries.
- Talk with your partner. Pressure makes it worse; teamwork makes it better.
- Struggling with stress or mood? MensLine Australia offers free 24/7 counselling on 1300 78 99 78.
See your GP if
- Erection problems keep happening
- You take nitrate medicines for angina
- You also have low sex drive, tiredness or breast changes
- Your penis has developed a bend or lump
- Problems started after a new medicine or prostate treatment
Get emergency help (call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries.) for chest pain during sex or exercise, or an erection that won’t go down after 4 hours.
Common questions
Is erectile dysfunction just part of getting older?
It becomes more common with age, but it is not inevitable. It can be an early sign of heart disease, diabetes or high blood pressure, so it is worth a check-up.
Is it safe to buy erection tablets online?
Only from a reputable pharmacy with a prescription. Products sold online without a prescription may be fake, poor quality or unsafe.
Why didn’t the tablets work for me?
They need sexual arousal, work best 1 to 2 hours after taking them, and can be blunted by a heavy meal, alcohol or anxiety. Judge them over 5 to 6 attempts before deciding.
Will erection tablets increase my sex drive?
No. They improve blood flow to the penis but do not increase desire. Low sex drive needs a separate check.
Helpful resources
- Healthdirect: Erectile dysfunctionClear overview of causes, treatments and Australian support services. Free, Australia.
- Healthy Male: Erectile dysfunctionMen’s health organisation’s guide to causes and treatment. Free, Australia.
- NHS: Erection problemsSelf-help steps and buying-online warnings. Free, UK.
Evidence and more information
- Healthdirect: Erectile dysfunction
- NHS: Erectile dysfunction (impotence)
- Australian Prescriber: Erectile dysfunction, causes, assessment and management
maladywise.com/erectile-dysfunction/